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HomeMy WebLinkAbout14251-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No. Z~ 3857 Date September ~6 1985 deck addition. THIS CERTIFIES that the building ................................................ Location of Property ...5?.0. .......... ?f..~.~.8.8. o...S.~... .............. Southold House No. Street · Hamlet County Tax Map No. 1000 Section ...... ~.8 .... Block ........ 3 ......Lot ..... .~.~. ......... X X X Subdivision ............................... Filed Map No ......... Lot No .............. conforms substantially to the Application for Building Permit heretofore fried in this office dated September 6 19 8.?pursuant to which Building Permit No. q~25q Z dated ...... .S .e.p.t.e.m..b.e.r..6. ......... 19...85, was issued, and confOrms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... Deck addition. WILLIAM ALBRO The certificate is issued to ..................... [o~,n'e;"~) ...................... of the aforesaid building. Suffolk County Department of Health Approval N/A UNDERWRITERS CERTIFICATE NO ..................... N.../.A .......................... Building Inspector Rev. 1/81 l~OR~ NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, N. Y. BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N~ 14251 Z Permission is hereby granted to: f,.~.~.e., ~. . ~.:.E ..... to ............. .C. ..~.~.~..t..~?.~:L ......... .~.~.~. ........ ~A~L~.~,~ ......................................................... at premises located at -~'--~. 0 ~L~i~ I~,~.J' e ~, ~ OU~'~o~/ County To× Mop No. 1000 Section V ~' Block ~ Lot No....~..~. ............... 8./.7 .~ pursuont to oppilcotion ~ted ............................................... ........ , 19... nd ~pprov~ by the Building Inspector. Building Inspector FORM NO. 6 TOWN OF SOUTHOLD Building Department Town Hall Southold, N.Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted in duplicate to the Building Inspec- tor with the following; for new buildings or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2.Final approval of Health Dept. of water supply and sewerage disposal-(S-9 form or equal). 3.Approval of electrical installation from Board of Fire Underwriters. 4. Commemial buildings, Industrial buildings, Multiple Residences and similar buildings and installa- tions, a certificate of Code compliance 'from the Architect or Engineer responsible for the building. 5.Submit Planning Board approval of completed site plan requirements where applicable. Bo For existing buildings (prior to April 1957), Non-conforming uses. or buildings and "pre-existing" land uses: 1. Accurate survey of peoperty showing all property lines, streets, buildings and unusual natural or topographic featu res. 2.Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent informa- tion required to prepare a certificate. C. Fees: ~r ~' - C.'~ ,~ /5- C'~ 1. Certificate of occupancy $5.00 2. Certificate of occupancy on pre-existing dwelling or land use L//t C(~-~-~,%~~ ~?~ci~, ~[' ~/~ © Z ,~-, 3. Copy of certificate of occupancy $1.00 Date ....9/(.'t 0,/,8~ .............. New Building ............. O~d or Pre-existing Building ............ Vacant Land ............. Location of Property ,. -~2G. · · -Wab~<d.~o· S~mee ~; ...................... ~out;~_olcl, ........... House No. Street Ham/et Owner or Owners of Property ...Wi[.1,i am..Al~o ......................................... County Tax Map No, 1000 Section ,, ,?.~ .......... Block . .~ ............ Lot.. ~6 ........... Subdivision ................................. Filed Map No ........... Lot No .............. Permit No. 142.~1 .... Date of Permit .9/6./8~..Applicant]~z~,z~e.nt~-~e~ ~- .Z. no ~ ...... '. - Health Dept. Approval .... ~/~, ................ Labor Dept. Approval ........................ Underwriters Approval .... ~T/~. ................ Planning Board Approval ...................... Request for Temporary Certificate ..................... Final Certificate ..... ~ ................ Fee Submitted ~..,.00 ......................... Construction on above described building.af~t~cr~t~ codes and regulations. 0,0.~ ~¢6~7 x~ FIELD INS~ECTION ~OO__NDiT%O_N .- ,~,j ~_t COMMENTS ;'OUNDATION (2nd) OUGH FRAME & PLUMBING INSULATION PER N. STATE ENERGY CODE Ye FINAL ADDITIONAL COMMENTS: TOWN OF $OUTHOLD BUJLDIHG DEPARTI~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~7/(~ 19 ~ ~f~ proved .............. t ( ...................... , 19 ........ Permit No ..................................... Disapproved a/c ............................................................................................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ..................................... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in triplicate to the BuiJdi Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicot;~ c. 'i'he work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such parr shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupol shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department far the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ~ The applicant agrees tb comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors an premises and irt buildings for necessary inspections. (Signature of applicant, or nome, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build¢ Nome of owner of premises ............. ...~......'~.........~....~...~..~ ............................................................................ i lit applicant is a corporate, signature of duly authorized bfficer. (Name and title of corporate officer) Builder's License No ..... ~....,......~../..~. ....... /?..~J.:...~.~..,J~'~ Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed work will be dane. Mop No.: ........................................ Lot No ...................... Street and Number .,,r~..~'.?.....,~.,.,~.~,.f/.~,S.~ ...... ,,-~,.'?'. ........................................... ~,.,.,~.¢,.~.,4. P,/,(~.. ............................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exisiting use and occupancy b. Intended use and occupancy County Tax Hap No. Dist. 1000 Section 7~ Block ~ Lot 3: Nature of work (check which applicable): New Building.. ................. Addition', ...~..~.~...~......~, Alteration .............. ..... r 1~,1~ Removal .................. Demolitior ..................... Other Wo~k ................................................. ~ (Description) 4. Estimated Cost ................. ~,~.~ .................... ~...Fee ............................... ~ ....................................................... (to be paid 6n filing this application) ,5. If dwelling, number of dwelling units ............................ Number of dwelling Onits on each floor ........................ If garage, number of cars .................................................................................. : ...................................................... 6. tf business, commercial or mixed occupancy, specify nature and extent of each type of use ........................ 7. Dimensions of existing structures, Jf any: Front ............................ Rear .......... ~ ..................... Depth ..... ............... Dimensions of same structure with alterations or additions: Front ...... /~O...!C../'~. .......... Rear ........................ Depth ................................ Height ............................ Number of StorJes ....... ,L ................. -- 8. Dimensions of entire new construction: Front .................................... Rear....~ ....................... Depth .................... Height .................... Number of Stories .................................................................................................................. 10. Date of Purchase ........................................................ Nome of Former~4 ~___v __.//Ox~nelr '": ............... " ................................ 12. Does proposed construction violate any zoning Iow, ordinance or regulation:I .......... ~..~..~ .................................. 13. Will lot be regroded ..... ~.~. ............... Will excess fill be removed from premises: ( ) Yes ( ) No Nome of Architect .............................................................. Address ................................ Phone No .................... Name of Contractor ............................................................ Address ................................ [~hona hie...~ ............... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and i,ndicate all set-back dimensions frf property lines. Give street and block number or description according to deed, :and show street names and indict whether interior or corner lot. STATE OF NEW YORK, ~c c COUNTY OF ................................ ~"~ ................................................................................................. being duly sworn, deposes and says that he is the applica~ (Name of individual signing contract) [ above named. He is the ......................................... .-...; .................. '.% ............................................... i .............. : .......................................... ( (Contractorrdgent, corporate officer, etc.) i of said owner or owners, and is duly autkr6'rized to perform or have performed the said work and to make and fi this application; that all statements contained in this application are true to the best of his knowledge and belief; ar that the work will be performed in the manner set forth in the application flied therewith. Sworn to ~......~...bef°re me this ~ 19...~.-~'.. .'/~-~?~"~"~'~'/I/~' .............. day of ........... ................... , ' .... . Notary Public .... ~ ........ ~.':':: '.~.':~ · ~.'.'.....; ...... County ~ ~~~l ~p , ,c~n~~.... ::il Jl'll~ ...........